Sarah took a warm soapy washcloth, and after having Alan stand and lean forward, gently wiped him throughly all over this buttocks, between them and gently over his anus, perineum and scrotum. After going over him once more sans soap, she patted him dry gently, pressing the soft towel into all his folds to wick away the water. It brought back memories of being washed by his mother in childhood to him. Compared to Sarah’s gentle touch, his memory of his mother’s manner was that it was much more rougher and unpleasant.

Sarah then had him walk over to the bed and lay down. She raised the level of the bed to her waist. Dr Young came over to join her.

”Alan, I am going to take a listen to your belly first.” Dr Young pulled down the sheet and raised up the front of his gown to nipple height after she said this. The sheet was down to his mid thighs, leaving his genitals fully exposed. Alan thought she would raise up the sheet to cover him, but she did not. His genital skin was still damp from Sarah’s washing, and this made the exposure to the room air even chillier. He peered down and could see his skin tighten further in response to this. Wrinkles formed along the shaft of his penis as the skin contracted and it pulled up to the point that it no longer lay over his pubic area, but pointed vertically toward the ceiling.

Sarah and Christine were both aware of this and Sarah was tempted to cover him but, thought better of it. It would have been awkwardly out of place for her to intrude, and it would imply that she thought Dr Young was neglecting Alan’s privacy.

Dr yYoung closed her eyes as she move the diaphragm of her stethoscope over Alan’s taut belly, “Just a few post enema gurgles as expected.”

She put the stethoscope back around her neck and then percussed all four quadrants, getting hollow tympanic resonance. She then percussed his liver with more solid thuds ensued that Alan could sense spreading deeper into his viscera. She then used both hands to palpate and moved methodically around. “Relax Alan, your belly is tight. Slow deep breaths.“ He did this and her hands sank more deeply causing some clearly audible gurgles. Her hands moved lower into Alan’s pubic area. He tensed slightly as she moved into this sensitive zone, but Dr Young immediately picked up on this, “Relax,” she said without looking up. “Have you emptied your bladder? It will be more comfortable for you when I am up inside your rectum with my finger or the scope if your bladder is empty. It feels empty.”

”He was peeing while he was expelling the enemas,” Sarah noted.

Just as Alan was finding the warm touch of her hands somewhat soothing, Dr Young was finished. She pulled the gown down and the sheet back up and turned to Sarah, “I am going to go ahead with a through rectal exam now, Sarah. Please grab me some gloves and surgilube.”

As Sarah went to gather these, Dr Young sat down on the bed next to Alan and looked down at him directly as she spoke, “Alan, this is going to be a very thorough exam. I am trying to determine the source of your bleeding, but I also want to try to determine why you are repeatedly becoming so constipated. I will need you to describe the sensations you are feeling at certain points of the exam. Your bowel function depends strongly on sensory feedback and we need to make sure this is working and you can sense fullness and stretching properly. I will also be asking you to either squeeze my finger or push like you are trying to hove a BM at various times to try to assess the function of the different muscles in your anus and rectum, so this will not be a passive exam. I will need your full cooperation and participation. We will be using several different positions, because your organs shift depending on your posture. This will include you squatting on the bed as this is the normal position for a bowel movement, so we will need you like that. Any questions so far?”

”No, but I’m not sure I can do this. Its been too much already.”

Sarah responded before Dr Young had a chance to, “Alan, you need to have this done. This has been going on far too long. You’ve been in misery. We need to find out what’s wrong and try to get you a normal life back. I’ll be right here with you. I know we can get you through this. We just need your trust and cooperation.”

Dr Young had turned to Sarah as she was trying to coax Alan, surprised somewhat at her officious effort to convince Alan, but she would not have formulated the argument any differently, “Your friend Sarah is right. She seems to have your best interests in mind and is genuinely concerned for your health. You have a good advocate in her. I’d listen to her if I were you.”

Alan looked down for few seconds and then back up and responded resignedly, “Alright. Please please go slow and be gentle. I’m sore back there.”

Sarah frowned a bit at Alan. She thought he was cute when he pleaded like this. “Of course we will. If something hurts, speak up, but you will have to endure some discomfort.”

”Agreed. We need to get started.“ Dr Young was eager to begin the exam. “We will start with you supine — more or less in the lithotomy position. We don‘t have stirrups in here, but you‘re young, strong and flexible, and with these two young women steadying your legs, it should be fine.”

Alan did know that supine meant on his back, but was not familiar with the word “lithotomy.” He reasoned “cutting stone” with some quick etymological analysis, but it made no sense to him.

”Alan, lay on your back sideways on the bed with your legs over the edge and feet on the ground first.” Dr Young moved her hands to indicate what she meant. “Next we will have you lift your legs up toward your chest with your knees bent. Sarah and Christine will sit on each side of you to hold your legs steady so you don’t get tired.“

Alan did as instructed and Sarah and Christine assumed their positions, on on each side of him. As he lifted his legs, they each put a hand behind his knee on their respective sides, to pull back and hold him up. “That’s it. Let us help you.” Sarah encouraged.

”Scoot your behind toward me so that it comes over the edge of the bed now, Alan” Dr Young had taken a position in front of him on a stool. When he shifted closer, she reached out and lifted his gown up to his upper chest exposing him completely below that level. He was so very aware of how completely exposed he was — his belly, penis. scrotum, perineum and anus all in view. But it was not quite sufficient for Dr Young, “Splay his legs a bit wider to separate his buttocks more and hand me that pillow to put under his lower back.” Sarah handed it to Dr Young and she wedged it between Alan’s lower back and the edge of the bed. This had the effect of tilting his hips upwards so that his anus was directly under her gaze.

Dr Young was pleased, “Perfect. Positioning is so important. This is optimal visualization and access. Your anus looks a little irritated from all that’s been done to you this morning. I promise to keep that in mind and take extra steps to keep things really well lubricated for you. I’m going to examine you with my fingers from the outside first. I’ll tell you when I am going to insert my finger.”

As Alan looked down at her, he could see her serious facial expression. She then grabbed a nearby gooseneck wheeled floor lamp and switched it on. It was so bright, it overwhelmed Alan’s eyes and he could no longer make out her face as it was so strongly backlit. He could feel the heat of the lamp on his bare skin. He could hear the sound of her donning her gloves. He felt her press the areas around his anus to the sides and then move upward onto his perineum, encroaching onto his scrotum gently. Much to his chagrin, this triggered the his sac to contract tightly up into a compact hemisphere. She made an attempt to try to examine his testicles, but they were so tightly contained and drawn up in the pouch of his scrotum, that she gave up and took her hands away. There was the snap of the hinged plastic cap of the lubricant tube being flipped open followed by the wet bubbly noise of it being squirted onto her finger.

“Alright Alan, I‘m going to insert my finger now. I am going to focus on the muscles of your anus first, so I will only be going in a short distance. Relax, but don’t bear down and push until I tell you. I want to try to assess the muscle tone in its natural neutral state.”

Dr Young lightly pressed the tip of her finger into the puckered recess in the middle of Alan’s anus and very gently palpated the ring of muscle surrounding it. Alan could not help but tighten his anus reflexively in response to this. This interfered with her assessment, “Try to stop clenching your bottom.“ Alan tried very hard but with limited success. Dr Young finished and took her finger away, then stood up to look at Alan.

”Next I am going to insert my finger completely into your rectum. Normally I would have you bear down and push to relax your anus to facilitate the entry of my finger, but this time, I want you to do nothing. In fact try to think of something else. What I want to assess is the what type of muscular reflexes you have when my finger fills your anal canal. How your body responds to being penetrated. That may provide some insight in to whether there is any neuromuscular dysfunction impairing your bowel movements “

Alan thought this was an odd request. He turned to his right and Sarah met his gaze and offered a reassuring smile. He decided this would be his focus.

Dr Young addressed Alan while looking at him with her hand held high and her shimmering gloved index finger pointing straight up, ”OK Alan, focus elsewhere. Here comes my finger.”

Alan felt the touch of Dr Young’s fingertip rapidly turn to pressure and then the always intense sensation when his anus would first yield to the penetration and the slippery sliding fullness inside the rings of muscle of his anal canal. The sensation caused him to squint and furrow his brow slightly and when Sarah saw this, she mirrored the expression in sympathetic recognition of what he was feeling. Alan found this very emotionally intense to be having this done to his bottom while locked eye to eye with Sarah. He realized he was becoming more and more attached to her. His mouth opened as the intensity of the experience overtook him. “Its okay”, she quietly whispered. His trance like state was finally broken by the disconcerting feeling of Dr Young withdrawing her finger a little too quickly.

Alan let out a sigh of relief and also of fatigue. The day had already been quite physically and emotionally taxing.

Perhaps sensing this, Dr Young announced that she would do one more component of the exam and then they would pause for a rest, “Alright Alan, next I am going to insert more finger as deeply as possible and I will be pushing forward and upward towards your pubic bone and then towards your belly button. I will be feeling your belly from the outside with my other hand. The goal is to assess the relative size and positions of your pelvic organs — your rectum and your bladder. I will also be pushing against your prostate and checking it, although I doubt at your age it is playing a role in any of your problems. This exam is going to cause you to feel a lot of pressure and at times, an urge to poop or pee. Try to relax as best you can. I will have you bear down this time as I insert my finger to ease that part of it for you. Any questions?”

Alan nodded no and then turned to Sarah again as he mentally prepared himself.

”Okay now, bear down,“ Dr Young ordered.

Alan took a breath in and held it, pushing down with his abdomen. He then felt embarrassed, face to face as he was with Sarah, as he obeyed Dr Young‘s instructions. His face became warm, partly from embarrassment, partly from bear down and pushing the blood to his cheeks. Then came Dr Young’s finger smoothly and swiftly all the way into his bottom. He could feel his pelvis shift slightly from he greater force she was exerting to get as deeply as she could and he could feel the closed fingers of her hand, the hilt of what she was impaling him with, push against his perineum and the inner aspects of his buttocks.

The pressure quickly became intense and he gasped and groaned a bit. Sarah stroked his head with the hand that was not supporting his leg, “Its okay, Alan. Try to relax. Breath in and out.”

Alan wanted to close his eyes to lessen his embarrassment, but he also needed the comfort of Sarah’s face and her words and he kept them open, seeking solace in her gaze.

Dr Young put her left hand on Alan’s lower abdomen, just above his pubic bone and began to push down with it as she arced her finger upward from inside his rectum.

”Uh ! Oh! I need to pee! Let me up!”

Dr Young kept going, “No you don’t. Your bladder is actually quite empty. Kept your breathing even. I need to have your abdominal muscles less tense to be able to palpate your bladder. Now I am going to go above your bladder, so the urinary urgency is going to go away.”

Dr Young got a puzzled look on her face as she felt higher, “There seems to be a rather sharp bend in your rectum.“

As she straightened this bend with her finger, it cause a retained portion of Alan’s last enema to rapidly flow downward into his rectum. This happened so suddenly, he was unable to tighten his anus quickly enough to prevent it from leaking out of him. The sensation cause him to panic, and his panic escalated as he felt the warm water flow down his buttocks and tailbone. He drew in a sharp breath and tried to sit up, mortified at this leakage.

Dr Young firmly pressed him back down onto his back, “It’s okay, its just clean water. Nothing messy. I’m done with this part. Relax.”

She withdrew her finger and took a clean white towel and patted and rubbed the wet parts of Alan’s bottom. When she took away the towel and he could see that it was just wet, but otherwise clean, he felt slightly relieved.

”Okay, time for a rest.” Dr young was peeling off her exam gloves as she said this. She had Sarah and Christine swivel Alan back to a normal position in the bed so he could rest. Sarah pulled his gown down and pulled up the sheet to cover him, then fluffed and repositioned his pillow.